Management of Acute Craniotomy Pain: The Analgesic Effect of Diclofenac Sodium-Tramadol or Paracetamol-Tramadol

Background and objective: There is currently no consensus on pain management after craniotomy in neurosurgical centers in the world. We have investigated either the addition of diclofenac sodium or paracetamol to tramadol for analgesia after craniotomy. Methods: Fifty patients were allocated randomly to receive an intravenous tramadol with diclofenac sodium (DT) or tramadol plus paracetamol (PT), in a double-blind, randomized study. Then, all patients received bolus doses of tramadol (1.5 mg/kg) every 6 hours during the first 24 hours. Discomfort, sedation, pain scores, and side effects were recorded for up to 24 hours. Results: Although there was no difference in visual analog scale scores between groups 15 and 30 minutes after extubation, and after 1 (t3), 8 (t5), 12 (t6), and 16 hours, the diclofenac-tramadol group had significantly lower scores 4 and 24 hours postoperatively (P < 0.05). The number of patients requiring supplementary meperidine was significantly higher in the PT group than in the DT group. Four patients in the DT group (16%) and 10 patients in the PT group (40%) complained of pain during the first 24 hours, despite the tramadol therapy and they were treated with intravenous meperidine (25 mg). Conclusions: Addition of either diclofenac sodium or paracetamol to tramadol provided effective postoperative analgesia and patient comfort, without causing any sedation or respiratory depression after major intracranial surgery. In addition, diclofenac sodium-tramadol combination provided better postoperative pain relief and less supplementary analgesics than paracetamol-tramadol combination.